Distal Graft Research Articles

Covered stent graft for distal stent graft-induced new entry after frozen elephant trunk operation for aortic dissection

Background: The aim of the study was to present our experience with covered stent graft to close the tear induced by distal stent after Frozen Elephant Trunk operation (FET). Methods: From November 2012 to July 2015, 21 patients suffering from distal Stent Graft New Entry (d-SINE) after FET accepted interventional treatment with a covered stent graft. Computer Tomographic Angiography (CTA) was performed at 3, 6 and 12 months after surgery to observe the position and shape of the stent and the eventual endoleaks. Results: All patients were implanted with a covered stent graft. After surgery, angiography showed that the stents were in the proper position and fully expanded. Two patients died after surgery. Followup was 24-55 (mean, 40 ± 10) months. No stroke, paraplegia, or death occurred. CTA showed that the stents had a proper form and were in the correct position without any displacement or endoleak. False lumen expansion did not occur. Parts of the false lumen showed thrombosis. Conclusion: The results suggest that implantation of covered stents in the descending aorta to manage d-SINE after FET may achieve a good therapeutic effect.

Repair soft-tissue defect in forefoot with reversed lateral soleus muscle flap

To summarize clinical application results of repair soft tissue defect in forefoot with a reversed lateral soleus muscle flap on peroneal artery pedicle. From January 2005 to January 2013, 8 patients with soft-tissue defect on forefoot were underwent reconstruction with a reversed lateral soleus muscle flap on peroneal artery pedicle. There were 6 males and 2 female, aged from 16 to 48 years with an average of 26.8 years old. The reversed lateral soleus muscle flap was transposed to the forefoot defect area, then immediate coverage of the muscle flaps were performed by a meshed split-thickness free skin graft. The donor site was closed directly. The muscle flap survey was observed after the repair of the forefoot. All muscle flaps had survived completely. No clinical vascular deficiency was found on muscle flaps postoperatively. One case occurred recipient area sustained insignificant superficial infection, one patient developed distal muscle flap small skin graft necrosis, and spontaneous heal by 2 weeks' change dressing. Follow-up period was ranged form 2.5 to 5.5 years with an average of 3.5 years postoperatively. A good contour was confirmed at the recipient area. According to Cedell questionnaire, 6 patients obtained good results and 2 fair. When the local skin flap or muscle flap application is limited, lateral soleus muscle flap survey is satisfactory after repair and very suitable for repair of soft tissue defect of forefoot.

Distal Fingertip Composite Graft in Amputation Salvaged through PGE-1 Assisted Treatment-A Case Report

Distal Fingertip Composite Graft in Amputation Salvaged through PGE-1 Assisted Treatment-A Case Report

The Impact of Distal Stent Graft–Induced New Entry on Aortic Remodeling of Chronic Type B Dissection

In chronic type B aortic dissection, late distal stent graft-induced new entry (SINE) has a possible negative role in long-term aortic remodeling. This study aimed to investigate the impact of SINE occurrence on survival by evaluating true and false lumen remodeling in thoracic and abdominal segments at midterm surveillance. This study enrolled 65 patients with chronic type B aortic dissection (DeBakey type IIIb), who had received hybrid thoracic endovascular aortic repair (TEVAR) and had completed surveillance for at least 3 years. The 3-year survival rate was 84.7%. The patients were classified into non-SINE (n= 47) and SINE (n= 18) groups. Serial computed tomography scans were used to analyze volumetric change, true and false lumens, and thrombus volume from arch to aortic bifurcation level. The SINE event occurred at a median of 22.5 months. In the SINE group, there was a significant interruption of the abdominal true lumen expansion in the second year (median 0.01 [interquartile range (IQR), -0.03 to 0.12] in the non-SINE group versus median -0.04 [IQR, -0.12 to 0.04] in the SINE group; p= 0.014). There was a significantly worse thoracic false lumen remodeling in the SINE group compared with the non-SINE group in the third year after the SINE event occurred (median 0 [IQR, -0.09 to 0.05] in the non-SINE group versus median 0.06 [IQR, 0 to 0.13] in the SINE group; p= 0.038). For chronic aortic dissection, late occurrence of distal SINE could influence abdominal true lumen expansion and thoracic false lumen shrinkage. Early reintervention for distal SINE could improve aortic remodeling in chronic aortic dissection.

Bizarre Parosteal Osteochondromatous Proliferation (Nora Lesion)

Bizarre parosteal osteochondromatous proliferation, also known as Nora lesion, is a rare benign surface lesion of the bone commonly affecting the hands and feet. It has an aggressive local growth pattern and high rate of recurrence post-excision. The authors report a case of recurred Nora lesion involving thumb metacarpal neck. En bloc resection with immediate reconstruction using distal radius bone graft was provided as a treatment with no clinical or radiological recurrence at 2-year follow-up.

Clavicular Osteochondral Graft as a Treatment of a Glenoid Bone Deficiency, a Comparison of Glenoid Resurfacing Capability Versus Coracoid Latarjet Transfer

The clavicular osteochondral graft was able to augment 44% of glenoid radial bone loss, compared to 33% achieved from the Latarjet graft. The aim of this study is to evaluate a distal clavicle osteochondral autograft as a possible option for treating glenoid bone loss in patients with instability. We compared clavicular augmentation with the Latarjet technique as a gold standard in glenoid deficiency treatment. Further, we calculated differences in articular cartilage thickness between clavicular grafts and native glenoids. Twenty-seven fresh frozen cadaver shoulders were dissected and distal clavicle excision was performed, In addition, we performed coracoid harvesting and graft preparation according to the Latarjet technique. Articular cartilage was measured on the glenoid side by making a saw cut perpendicular to the articular surface along the long axis, and measuring the thinkness with a digital micrometer. The distal clavicular graft was similarly evaluated for cartilage thickness. The distal clavicular osteochondral autograft resulted in significantly greater glenoid radius restoration compared to a Latarjet graft, p<0.0001. The clavicular osteochondral graft was able to augment 44% of glenoid radial bone loss, compared to 33% achieved from the Latarjet graft. In all specimens articular cartilage was present at the clavicular grafts, but was 1,44 mm thinner than the native glenoids, p<0.0001. Distal clavicular osteochondral graft may resurface a greater amount of glenoid radius when compared to a Latarjet coracoid graft. It’s cartilage is of similar thickness to that of the native glenoid, and may provide a reasonable option for treatment of glenoid bone loss in the setting of anterior instability.

Thoracic endovascular aortic repair migration and aortic elongation differentiated using dual reference point analysis

ObjectiveWe evaluated images of patients undergoing a thoracic endovascular aortic repair procedure using two reference points as a means for differentiating stent graft migration from aortic elongation. Conventional standards define migration of a stent graft as an absolute change in the distance from the distal graft ring to a distal landmark ≥10 mm compared with a baseline measurement. Aortic elongation occurs over time in both healthy individuals and patients with aortic disease. Aortic elongation in patients with stent grafts may result in increased distal thoracic aortic lengths over time. False-positive stent graft migration would be defined when these patients meet the standard definition for migration, even if the stent has not moved in relation to the elongating aorta. MethodsThis retrospective study evaluated the aortic length of 23 patients treated with the conformable GORE TAG thoracic endoprosthesis (W. L. Gore & Associates, Flagstaff, Ariz) in three clinical trials (dissection, traumatic injury, and aneurysm). Patients who met the standard definition for migration were selected. A standardized protocol was used to measure aortic centerline lengths, including the innominate artery (IA) to the most distal device ring, the IA to the celiac artery (CA), and the distal ring to the CA. Baseline lengths obtained from the first postoperative image were compared with length measurements obtained from the first interval at which they met the standard definition for migration. The conventional standards for migration using a single reference point were compared with the use of dual reference points. ResultsOf the 23 patients with endograft changes, 20 were deemed to have aortic elongation rather than true migration. The remaining three patients were deemed to have migration on the basis of the IA to distal ring position compared with the IA to CA length change. The IA to CA interval length change was markedly greater in those with elongation compared with migration (23.8 ± 8.4 mm vs −3.5 ± 5.4 mm, respectively; P < .05). The distal ring to CA interval length change was greater in patients showing elongation rather than migration (18.5 ± 6.6 mm vs −9.8 ± 5.4 mm, respectively; P < .05). The distance between the IA and distal ring was similar for elongation and migration. ConclusionsThese results highlight the dynamic changes that can occur in the aorta as a natural consequence of age. Employing two landmarks can account for these changes and proves to be an important factor, among others, in the differentiation of aortic elongation from true stent graft migration.

Clinical and Angiographic Outcomes in Coronary Artery Bypass Surgery with Multiple versus Single Distal Target Grafts.

Coronary artery bypass grafting (CABG) with multiple distal target (MDT) grafts requires less graft material and reduces cardiopulmonary bypass time; however, there may be a higher incidence of graft failure. A real-world analysis reporting long-term outcomes associated with MDT grafts is lacking. In 6262 consecutive patients who underwent an isolated first CABG from 2004-2012, patients with MDTs were propensity matched to those with single distal target (SDT) grafts. Logistic regression adjusted for traditional, anatomical, and functional definitions of complete revascularization (CR). Outcomes included 30-day, 1-year, and long-term mortality (median 6.29 years).Results: A total of 549 (8.8%) CABG patients had a MDT graft. CR defined using traditional (96.1% versus 92.0%, P = .005), anatomical (89.0% versus 80.20%, P < .001), and functional (90.7% versus 82.6, P < .001) definitions was more frequent in MDT patients. No significant differences in mortality were observed at 30 days (2% versus 3.3%, P = .18), 1-year (3.8% versus 4.9%, P = .37), or through end of follow-up (18.0% versus 16.6% P = .52) between the MDT and SDT groups, respectively. Similarly, no differences were observed after adjustment for all definitions of CR. Graft failure in MDT and SDT patients was 37.8% and 27.6%, respectively (P = .18). In a contemporary population-based cohort, no differences in mortality were observed between CABG patients with MDT and SDT grafts. Our findings support the safety of MDT grafts to facilitate CR in patients and when graft material is limited.

Combining Constitutively Active Rheb Expression and Chondroitinase Promotes Functional Axonal Regeneration after Cervical Spinal Cord Injury

After spinal cord injury (SCI), severed axons in the adult mammalian CNS are unable to mount a robust regenerative response. In addition, the glial scar at the lesion site further restricts the regenerative potential of axons. We hypothesized that a combinatorial approach coincidentally targeting these obstacles would promote axonal regeneration. We combined (1) transplantation of a growth-permissive peripheral nerve graft (PNG) into an incomplete, cervical lesion cavity; (2) transduction of neurons rostral to the SCI site to express constitutively active Rheb (caRheb; a Ras homolog enriched in brain), a GTPase that directly activates the growth-promoting pathway mammalian target of rapamycin (mTOR) via AAV-caRheb injection; and (3) digestion of growth-inhibitory chondroitin sulfate proteoglycans within the glial scar at the distal PNG interface using the bacterial enzyme chondroitinase ABC (ChABC). We found that expressing caRheb in neurons post-SCI results in modestly yet significantly more axons regenerating across a ChABC-treated distal graft interface into caudal spinal cord than either treatment alone. Excitingly, we found that caRheb+ChABC treatment significantly potentiates the formation of synapses in the host spinal cord and improves the animals' ability to use the affected forelimb. Thus, this combination strategy enhances functional axonal regeneration following a cervical SCI.

Tibiotalocalcaneal (TTC) arthrodesis with reverse PHILOS plate and medial cannulated screws with lateral approach

BackgroundTibiotalocalcaneal arthrodesis is most common and effective surgical treatment for severe hindfoot pathology, but the fusion rate is often lower than the ordinary tibiotalar arthrodesis because of the more serious joint disease associated with obvious deformity and osteoporosis. Recent literature describe tibiotalocalcaneal arthrodesis with reverse PHILOS plate with good clinical outcome result, though some patients non-union, due to eccentric force of the plate may be hidden. The purpose of this study was to evaluate clinical outcome of the lateral approach for tibiotalocalcaneal (TTC) arthrodesis with reverse PHILOS Plate and medial cannulated screw.MethodsBetween Jun, 2013 to April, 2015 12 patient with hindfoot pathology had TTC arthrodesis with a reverse PHILOS plate with medial cannulated screw through a lateral approach with resection of the distal fibula and bone graft. Perioperatively observe for wound and neurovascular status. Patients were follow-up from post-operative 1, 3, 6 and12 months, to observation of wound healing, ankle pain, subtalar Joint Fusion, internal fixation and ankle function. Ankle function were scored according to the American Orthopaedic Foot and Ankle Society(AOFAS) Ankle-Hindfoot Scale system.ResultsTwelve ankle fusion all patient follow-up, with mean time to surgery 18.6 months (12-36 month). No cases infection and issue necrosis; one patient complaint of lateral foot numbness we observe and follow-up was spontaneously recovery after 3 months. After 3 months of operation, no obvious pain of ankle joint and internal fixations loose were found. Almost fusion and good axial alignment of TTC joint also were found by X-ray and CT examination. After final fellow-up of each case, no case complain of pain of ankle joint, good fusion and axial alignment of TTC joint were also all found through Terminology. The mean American Orthopaedic Foot and Ankle society (AOFAS) score average was 77.5.ConclusionTTC arthrodesis with reverse PHILOS Plate and medial cannulated screw have advantages of clear incision, effective bone orthopaedic and graft fully secure, stable internal fixation, high fusion rate and less complications, can effectively correct deformities, alleviate hindfoot pain and improve function, and is an effective method of treatment of after severe hindfoot disease.Trial registrationThis trial is registered on ClinicalTrials.gov with reference number: ID: NCT02977910. Registered 26 Nov 2016, retrospectively registered.

Arthroscopic Anatomic Glenoid Reconstruction: Analysis of the Learning Curve

Objectives:This procedure involves the use of distal tibial bone graft to recreate anterior glenoid bone surface with the goal of preventing further dislocations. Recently, an arthroscopic approach has been proposed for this procedure, which uses a similar technique to the Bankart repair. This approach requires one additional medial portal (4 total), for graft placement, and this is established using an insideout technique; it avoids damage to the subscapularis tendon, and preserves the capsule and labrum. By comparison, the Arthroscopic Latarjet technique requires four additional new portals and requires splitting of the subscapularis tendon, as well as excision of the capsule and labrum. This study seeks to (1) identify a learning curve for this procedure, and (2) compare this to the learning curve for Arthroscopic Latarjet.Methods:Fiftyseven cases of surgically treated recurrent anterior shoulder instability were reviewed. All operations were carried out with the patient in a lateral decubitus position. Twentynine patients were managed with the Arthroscopic Latarjet procedure using coracoid bone graft, and 28 were treated with Arthroscopic Anatomic Glenoid Reconstruction using distal tibial bone graft. Procedure start and stop times were recorded and procedure durations calculated.Results:In the case of Arthroscopic Latarjet, the first 14 cases took an average 184 minutes to perform, with the remaining cases in the cohort averaging 116 minutes each in duration. For Arthroscopic Anatomical Glenoid Reconstruction, the first 14 cases took an average of 90 minutes, with the remaining cases averaging 84 minutes each.Conclusion:Arthroscopic Anatomic Glenoid Reconstruction is faster to perform compared to the Arthroscopic Latarjet. Further investigations into the safety and efficacy of this procedure will help determine whether it is a better choice for surgeons looking to learn the skill of boney augmentation for recurrent anterior instability.

Midterm outcomes and evolution of gutter area after endovascular aneurysm repair with the chimney graft procedure

ObjectiveThe objective of this study was to describe our experience with endovascular aneurysm repair (EVAR) with the use of chimney grafts for branch vessel preservation. MethodsPatients treated with a chimney graft procedure between October 2009 and May 2015 were included for analysis. Patients who were not considered eligible for open surgical repair or for conventional, branched, or fenestrated endovascular repair were selected. A standardized operating procedure with left brachial or axillary artery cutdown access for the chimney grafts and bilateral femoral artery cutdown access for the aortic main device was used. Outcomes were noted according to the Society for Vascular Surgery reporting standards. In addition, evolution of gutter area over time was determined. Estimated rates of survival, freedom from aneurysm growth, and clinical success at 24 months of follow-up were calculated. ResultsThirty-three patients (mean age, 77.6 ± 6.8 years; 87.9% male) with a mean preoperative maximum aneurysm diameter of 71.7 ± 13.5 mm were included. A total of 54 of an intended 54 chimney grafts were deployed. Primary technical success and 30-day secondary clinical success rates were 87.9% and 84.8%, respectively. The early mortality rate was 6.1% (n = 2). The early type IA endoleak rate was 6.1% (n = 2), and the chimney graft occlusion rate was 6.1% (n = 2). Median follow-up duration was 26 months (interquartile range, 14.8-37.3 months). The estimated 2-year actuarial survival rate was 78.1% (standard error, ±7.4%). Late complications included type IA endoleak (n = 1), chimney graft occlusion (n = 2), type II endoleak with aneurysm growth (n = 4), and distal stent graft limb kinking and occlusion (n = 1). Late reinterventions included coil or glue embolization (n = 3), distal limb extension (n = 2), open endoleak ligation (n = 2), Palmaz stent placement (n = 1), repeated EVAR (n = 1), and femorofemoral bypass graft (n = 1). At 2 years, the estimated secondary clinical success and freedom from aneurysm growth rates were 80.5% (±7.2%) and 84.4% (±7.2%). Gutter size showed a small but significant decrease over time at the level of the proximal markers and at 10 mm distal from the markers. ConclusionsMidterm results show that a standardized procedure for EVAR using chimney grafts for branch vessel preservation is an acceptable option for high-risk patients with large, complex aneurysms who are unfit for open repair and who have been excluded from fenestrated EVAR. Gutter size decreases over time, but the rate of branch vessel loss and reinterventions demonstrate that this approach should remain reserved for those who are at truly prohibitive risk for open or fenestrated stent graft repair.

Durability of a low-profile stent graft for thoracic endovascular aneurysm repair

ObjectiveThe introduction of lower profile endografts expanded the application of aortic endovascular repair. However, evidence about their durability is still scarce. The objective of this study was to assess longer term durability of the Zenith Alpha Thoracic Stent Graft (Cook Inc, Bloomington, Ind) after thoracic endovascular aortic repair. MethodsProspectively collected data of all patients treated for thoracic aortic aneurysms or penetrating aortic ulcers and having computed tomography angiography-based follow-up of ≥12 months were retrospectively analyzed. The primary end point was ongoing clinical success. Among the secondary end points, stent graft migration and fracture were analyzed. ResultsBetween August 2010 and October 2015, 70 consecutive patients were treated in a single center with the Zenith Alpha stent graft. With computed tomography angiography-based follow-up of 22.3 ± 15.9 months, ongoing clinical success was 87.1%. There were three cases of type IA endoleak (4.3%), two cases of type IB endoleak (2.9%), and one case of aneurysm sac enlargement (1.4%). Five patients died postoperatively (7.1%). No type III or type IV endoleak was detected; there was one case of distal stent graft migration and no stent fracture. Reintervention was necessary in one case (1.4%) of a combined type IA and type II endoleak. There were no conversions to open repair and no ruptures or intraoperative deaths. All-cause mortality was 17.1% at 76 months. ConclusionsThe Zenith Alpha Thoracic Stent Graft appears to maintain favorable results in a longer time frame with a low incidence of aneurysm sac growth and migration. Results from multicenter prospective trials are needed to validate these data.

Optimisation of a Novel Spiral-Inducing Bypass Graft Using Computational Fluid Dynamics

Graft failure is currently a major concern for medical practitioners in treating Peripheral Vascular Disease (PVD) and Coronary Artery Disease (CAD). It is now widely accepted that unfavourable haemodynamic conditions play an essential role in the formation and development of intimal hyperplasia, which is the main cause of graft failure. This paper uses Computational Fluid Dynamics (CFD) to conduct a parametric study to enhance the design and performance of a novel prosthetic graft, which utilises internal ridge(s) to induce spiral flow. This design is primarily based on the identification of the blood flow as spiral in the whole arterial system and is believed to improve the graft longevity and patency rates at distal graft anastomoses. Four different design parameters were assessed in this work and the trailing edge orientation of the ridge was identified as the most important parameter to induce physiological swirling flow, while the height of the ridge also significantly contributed to the enhanced performance of this type of graft. Building on these conclusions, an enhanced configuration of spiral graft is proposed and compared against conventional and spiral grafts to reaffirm its potential benefits.

Superior Lower Extremity Vein Graft Bypass Patency among Married Patients with Peripheral Artery Disease

Outcome disparities associated with lower extremity bypass (LEB) for peripheral artery disease (PAD) have been identified but are poorly understood. Marital status may affect outcomes through factors related to health risk behaviors, adherence, and access to care but has not been characterized as a predictor of surgical outcomes and is often omitted from administrative data sets. We evaluated associations between marital status and vein graft patency following LEB using multivariable models adjusting for established risk factors. Consecutive patients undergoing autogenous LEB for PAD were identified and analyzed. Survival analysis and Cox proportional hazards models were used to evaluate patency stratified by marital status (married versus single, divorced, or widow[er]) adjusting for demographic, comorbidity, and anatomic factors in multivariable models. Seventy-three participants who underwent 79 autogenous vein LEB had complete data and were analyzed. Forty-three patients (58.9%) were married, and 30 (41.1%) were unmarried. Compared with unmarried patients, married patients were older at the time of their bypass procedure (67.3±10.8years vs. 62.2±10.6years; P=0.05). Married patients also had a lower prevalence of female gender (11.6% vs. 33.3%; P=0.02). Diabetes, hypertension, hyperlipidemia, and smoking were common among both married and unmarried patients. Minimum great saphenous vein conduit diameters were larger in married versus unmarried patients (2.82±0.57mm vs. 2.52±0.65mm; P=0.04). Twenty-four-month primary patency was 66% for married versus 38% for unmarried patients. In a multivariable proportional hazards model adjusting for proximal and distal graft inflow/outflow, medications, gender, age, race, smoking, diabetes, and minimum vein graft diameter, married status was associated with superior primary patency (hazard ratio [HR] = 0.33; 95% confidence limits [0.11, 0.99]; P=0.05); other predictive covariates included preoperative antiplatelet therapy (HR=0.27; 95% confidence limits [0.10,0.74]; P=0.01) and diabetes (HR = 2.56; 95% confidence limits [0.93-7.04]; P=0.07). Marital status is associated with vein graft patency following LEB. Further investigation into the mechanistic explanation for improved patency among married patients may provide insight into social or behavioral factors influencing other disparities associated with LEB outcomes.

Vascularized distal radius graft of 1, 2 intercompartmental supraretinacular artery for scaphoid nonunion

Objective To study the techniques and outcomes of using a retrograde pedicled vascularized radius bone flap based on the 1st, 2nd intercompartmental supraretinacular artery (1, 2ICSRA) for scaphoid nonunion through dorsal and palmar approaches. Methods Between March 2013 and April 2015, 16 patients with scaphoid nonunion were treated by surgery through palmar and dorsal approaches. There were 14 males and 2 females with an average age of 29.1 years (range, 19-51 years). The location of lesion was 6 cases on the left and 10 cases on the right. 5 cases were treated with plaster fixation. 11 cases weren’t treated after wrists injured. The preoperative time was 6-26 months, with an average of 16.5 months. The operation was completed within one incision. The bone flaps based on 1, 2ICSRA were taken through dorsal approach. The broken ends of the scaphoid fracture were cleaned, and the deformity was corrected with bone grafting and internal fixation through palmar approach. Time of fracture union and wrist pain resolution was evaluated. Wrist motion and grip strength were measured and compared. The result of the latest follow-up was used as the criterion for efficacy evaluation. The wrist pain was evaluated using visual analogue scale (VAS) and the postoperative wrist function based on the modified Mayo wrist score was recorded. Results Post-operative follow up ranged from 6-19 months, with an average of 11 months. Bone union was achieved in all the cases, so the healing rate was 100%. 7 cases were healed in 11 weeks. 5 cases were healed in 13 weeks. 3 cases were healed in 15 weeks. 1 case was healed in 17 weeks. The average healing time was 12.5 weeks. The humpback deformity of Scaphoid and DISI of 7 cases were corrected. The bending of wrist could reach 60.2°±3.2°, and the elongation could reach 51.3°± 3.5°. The radial deviation of wrist could reach 13.6°±1.42°, and ulnar deviation could reach 24.4°±1.8°. The range of grip strength was 29-64 kg, with an average of 45 kg. The 16 patients returned to normal work. The pain after wrist movement of 14 cases was completely disappeared, and the VAS was 0. Two cases felt slight pain when wrist was overworked, and the VAS were 0.9 and 1.2. The wrist joint function of patients recovered well. The modified Mayo score was 69-99, with an average of 90.75. The functional results were 12 excellent, 2 good, and 2 fair, and the excellent and good rate was 87.5% (14/16) . No complications such as infection, failure of screws, orthopaedic arthritis or scaphoid necrosis were found during the follow-up period. Conclusion The technique of 1, 2 ICSRA pedicled bone graft and palmar bone grafting for nonunion of scaphoid can provide convenience for us to deal with the broken ends of the scaphoid fracture, correct the malformation and graft bone through dorsal and palmar approaches. This method can protect the blood supply of the scaphoid, and promote scaphoid union. Key words: Scaphoid bone; Fractures, ununited; Bone transplantation

The Graft Bending Angle Can Affect Early Graft Healing After Anterior Cruciate Ligament Reconstruction: In Vivo Analysis With 2 Years’ Follow-up

Background: A high graft bending angle (GBA) after anterior cruciate ligament (ACL) reconstruction has been suggested to cause stress on the graft. Nevertheless, evidence about its effect on graft healing in vivo is limited. Hypothesis: The signal intensity on magnetic resonance imaging (MRI) would be higher in the proximal region of the ACL graft, and higher signals would be correlated to a higher GBA. Study Design: Descriptive laboratory study. Methods: Anatomic single-bundle ACL reconstruction was performed on 24 patients (mean age, 20 ± 4 years) using the transportal technique. A quadriceps tendon autograft with a bone plug was harvested. To evaluate graft healing, the signal/noise quotient (SNQ) was measured in 3 regions of interest (ROIs) of the proximal, midsubstance, and distal ACL graft using high-resolution MRI (0.45 × 0.45 × 0.70 mm), with decreased signals suggesting improved healing. Dynamic knee motion was examined during treadmill walking and running to assess the in vivo GBA. The GBA was calculated from the 3-dimensional angle between the graft and femoral tunnel vectors at each motion frame, based on tibiofemoral kinematics determined from dynamic stereo X-ray analysis. Graft healing and GBAs were assessed at 6 and 24 months postoperatively. Repeated-measures analysis of variance was used to compare the SNQ in the 3 ROIs at 2 time points. Pearson correlations were used to analyze the relationship between the SNQ and mean GBA during 0% to 15% of the gait cycle. Results: The SNQ of the ACL graft in the proximal region was significantly higher than in the midsubstance (P = .022) and distal regions (P < .001) at 6 months. The SNQ in the proximal region was highly correlated with the GBA during standing (R = 0.64, P < .001), walking (R = 0.65, P = .002), and running (R = 0.54, P = .015) but not in the other regions. At 24 months, signals in the proximal and midsubstance regions decreased significantly compared with 6 months (P < .001 and P = .008, respectively), with no difference across the graft area. Conclusion: The signal intensity was highest in the proximal region and lowest in the distal region of the reconstructed graft at 6 months postoperatively. A steep GBA was significantly correlated with high signal intensities of the proximal graft in this early period. A steep GBA may negatively affect proximal graft healing after ACL reconstruction.

Distal clavicle autograft—I would like to use my own osteochondral graft please

Recent work has demonstrated the importance of addressing bone loss in the surgical management of anterior shoulder instability. Multiple options exist for reconstituting the glenoid articular surface to include: anatomic versus non-anatomic techniques and utilizing autograft versus allograft material. Anatomic restoration via an arthroscopic approach with distal clavicle osteochondral autograft (DCA) is the senior author’s preferred technique when bone grafting is indicated for instability cases. This technique offers a low cost, readily available, and reproducible means of obtaining autograft material. Moreover, the distal clavicle graft provides an anatomic restoration of the glenoid radius with an articular cartilage cap comparable in thickness to that of the native glenoid. Along with a summary of the pertinent literature, this review article outlines the rationale, indications, and technical notes for this procedure.

Distal Radius Bone Graft From the Second Extensor Compartment: A Safe and Effective Technique.

We describe a technique for harvesting cancellous bone graft from the floor of the second extensor compartment that is both easy and effective. It confines surgery to a single operative field under the same regional anesthesia and tourniquet as the primary hand surgical procedure while at the same time allowing wide visualization for harvesting bone graft. It provides cancellous bone of sufficient quality and quantity for use in most hand surgical cases. The technique has so far been used in 80 patients and has proven to be very safe.

Non-contrast MR angiography at 1.5 Tesla for aortic monitoring in Marfan patients after aortic root surgery

BackgroundContrast-enhanced cardiovascular magnetic resonance angiography (CE-CMRA) is the established imaging modality for patients with Marfan syndrome requiring life-long annual aortic imaging before and after aortic root replacement. Contrast-free CMRA techniques avoiding side-effects of contrast media are highly desirable for serial imaging but have not been evaluated in the postoperative setup of Marfan patients. The purpose of this study was to assess the feasibility of non-contrast balanced steady-state free precession (bSSFP) magnetic resonance imaging for aortic monitoring of postoperative patients with Marfan syndrome.MethodsSixty-four adult Marfan patients after aortic root replacement were prospectively included. Fourteen patients (22%) had a residual aortic dissection after surgical treatment of type A dissection. bSSFP imaging and CE-CMRA were performed at 1.5 Tesla. Two radiologists evaluated the images regarding image quality (1 = poor, 4 = excellent), artifacts (1 = severe, 4 = none) and aortic pathologies. Readers measured the aortic diameters at defined levels in both techniques. Statistics included observer agreement for image scoring and diameter measurements and ROC analyses for comparison of the diagnostic performance of bSSFP and CE-CMRA.ResultsBoth readers observed no significant differences in image quality between bSSFP and CE-CMRA and found a median image quality score of 4 for both techniques (all p > .05). No significant differences were found regarding the frequency of image artifacts in both sequences (all p > .05). Sensitivity and specificity for detection of aortic dissections was 100% for both readers and techniques. Compared to bSSFP imaging, CE-CMRA resulted in higher diameters (mean bias, 0.9 mm; p < .05). The inter-observer biases of diameter measurements were not significantly different (all p > .05), except for the distal graft anastomosis (p = .001). Using both techniques, the readers correctly identified a graft suture dehiscence with aneurysm formation requiring surgery.ConclusionUnenhanced bSSFP CMR imaging allows for riskless aortic monitoring with high diagnostic accuracy in Marfan patients after aortic root surgery.